Provider Demographics
NPI:1477364636
Name:DORDEVIC, DUSAN (ARNP)
Entity type:Individual
Prefix:
First Name:DUSAN
Middle Name:
Last Name:DORDEVIC
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E ROWAN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1203
Mailing Address - Country:US
Mailing Address - Phone:509-489-3554
Mailing Address - Fax:509-489-3558
Practice Address - Street 1:220 E ROWAN AVE STE 300
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1203
Practice Address - Country:US
Practice Address - Phone:509-489-3554
Practice Address - Fax:509-489-3558
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61654357363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily